New-Onset Inflammatory Bowel Diseases Among IL-17 inhibitors-Treated Patients: Results From The Case-Control MISSIL Study

OBJECTIVES

To describe new-onset inflammatory bowel diseases (new IBD) in patients treated with interleukin 17 inhibitors (IL-17i), to assess their incidence and to identify their risk factors in real life.

METHODS

A French national registry (MISSIL) aimed to report all cases of new IBD in patients treated with IL-17i from January 2016 to December 2019. Using the estimated number of patients treated by IL-17 in France during the study period, the annual incidence rates of new IBD was reported in IL-17i-treated patients. A case-control study was performed with two controls per new IBD case matched by gender, age and underlying inflammatory disease.

RESULTS

31 cases of new IBD under IL-17i were collected: 27 patients treated for spondyloarthritis and 4 patients for psoriasis. All were observed with secukinumab (SEK). The median time to onset of new IBD symptoms was 4.0 (1.5-7.5) months. SEK was discontinued in all patients. The evolution was favourable with complete resolution (17/31), improvement (7/31) or stabilization (5/31). 2 patients died: one due to a massive myocardial infarction and one due to post-colectomy complications. The incidence of new IBD decreased from 0.69/100 PY (7/1010) in 2016, to 0.08/100PY (6/7951) in 2019. No previous treatment with etanercept (OR = 0.33, IC95% 0.14-0.80, p= 0.014) and low number of previous biological therapies (OR = 0.67, 95%CI 0.47-0.94, p= 0.021) were significantly associated with new IBD.

CONCLUSION

The incidence of new IBD was low and decreased from 2016 to 2019. The outcome was favourable in 24 out of 31 patients, but two patients died.

Cytomegalovirus ventriculoencephalitis presenting with hydrocephalus in a patient with advanced HIV infection

A 38-year-old lady with advanced human immunodeficiency virus (HIV) infection presented to the emergency department with headache, vomiting and fluctuating alertness for 3 weeks. On examination, she had tachycardia, bilateral papilledema, restriction of upward gaze, gaze-evoked nystagmus and signs of meningeal irritation. Magnetic resonance imaging of the brain showed hydrocephalus and periventricular high T2-signal regions with restriction on diffusion-weighted imaging. Polymerase chain reaction done on the cerebrospinal fluid obtained after the insertion of an external ventricular drain was positive for cytomegalovirus (CMV). She was treated with intravenous ganciclovir followed by oral valganciclovir with which she made a dramatic recovery. CMV ventriculoencephalitis can present with hydrocephalus in HIV-infected individuals. A high index of suspicion must be maintained to diagnose this disease and start appropriate therapy on time.

Tolerance of colonoscopy and questioning its utility in the elderly population

This study was carried out from Jan '12-Dec '12 to assess current practice in Kerry General Hospital against the age related indicators for colonoscopies. A total of 1474 colonoscopies were performed, 1177 (79.9%) were diagnostic and 297 (20.10%) were therapeutic, patients were divided into 4 age groups under 75, 75-80, 81-85, 86+. The trend analysis revealed an increase in diagnostic colonoscopies and decrease in therapeutic colonoscopies with age. 664 (45.04%) of colonoscopies were reported normal which made up the majority of the total diagnoses, 1330 (90.2%) of colonoscopies occurred without any complications. Main complications were patient discomfort being the highest, present in 112 (7.6%) of patients, and lowest being urticaria around the IV site present in 1 (0.1%) of the cases. Patient discomfort was higher in younger patients as evidenced by 98 cases aged < 75, followed by 11 cases aged 75-80, 2 cases aged 81-85 and 1 case aged > 86. Highest percentage of poor tolerance was found in 14 (1.1%) of total patients < 75, 1 (0.8%) of total patients aged 75-80, 1(1.7%) of total patients in age group 81-85 and none (0%) in age group > 86. We have established the safety of colonoscopy, low rate of complications and a better tolerance in the elderly from this study, however, its utility, especially in presence of other comorbidities in elderly is questionable.

Omentum prevents intestinal adhesions to mesh graft in abdominal infections and serosal defects

BACKGROUND

Many studies have evaluated the use of grafts in the reconstruction of abdominal wall defects. In this study, the effects resulting from the presence or absence of the omentum were evaluated in the setting of infection or serosal defects in the formation of adhesions in abdominal closures using mesh grafts.

METHODS

For this study, 60 Wistar albino rats were divided into six groups. A circular 3.79-cm(2) fascioperitoneal defect was created. After group-specific procedures, defects were reconstructed using polypropylene mesh grafts. In group C (control group), only a mesh graft recontruction was performed, whereas group O (O for omentectomy) underwent an omentectomy plus mesh closure. In group SD (serosal defect group), the cecum was abrased with a brush before mesh closure. Group SDO underwent cecal abrasion plus an omentectomy. In group I (infection group), the intraabdominal space was filled with 1 ml of solution containing 100,000 colony-forming units (CFUs) of Escherichia coli per milliliter. Group IO received the same same amount of E. coli solution plus an omentectomy before mesh closure. After 28 days, the groups were evaluated by intraabdominal and blood cultures, grading of intraabdominal adhesions, graft-organ adhesions, proportion of adhesions to graft size, and histopathologic studies. The results were statistically evaluated using one-way variant analysis and Scheffe's and Fisher's definite chi-square tests.

RESULTS

For the groups in which the greater omentum was preserved, intestinal adhesions to the graft surface were less frequently observed, especially in cases with intraabdominal infections and serosal defects (p < 0.05).

CONCLUSIONS

Preservation of the greater omentum reduces the formation of intestinal adhesions, especially in cases with underlying infections and serosal defects in abdominal closures using mesh grafts. This could be beneficial in related clinical situations in lowering the rate of intestinal fistulas, erosions, and obstructions that can be attributed to the formation of adhesions.

Radiation exposure of trainee anaesthetists

This prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.

Adherence of Candida albicans to glow-discharge modified acrylic denture base polymers

An important aetiologic factor in the pathogenesis of denture-induced stomatitis, is the presence of numerous yeasts, usually Candida albicans, on the fitting surfaces of dentures. In the present study, effect of glow-discharge plasma, a technique applied to increase surface wettability of acrylic resins, on candidial adherence was evaluated. The durability of glow-discharge modification with saliva coating was also evaluated. Samples including control and experimental groups were prepared by using heat compression mould technique. To create a hydrophobicity gradient, experimental groups were exposed to a radiofrequency glow discharge in an O2 atmosphere under different discharge powers. To characterize the wetting properties, an expression of surface hydrophobicity, contact angle measurements were performed by the sessile drop method. The organism used was C. albicans (ATTC10321). Acrylic samples were coated with unstimulated whole saliva collected from a healthy man. The fungal suspension was poured on saliva-inoculated samples and incubated at 37 degrees for 2 h. The samples were then fixed with glutaraldehyde and Gram stained. Adhered candidial cells were examined by light microscope. Diffuse Reflectance FTIR (DRIFT) and scanning electron-microscope examinations were also performed to evaluate the surface composition and roughness of the test groups. Glow-discharge plasma was found to be an effective means of increasing surface wettability even with salivary pellicle. Amounts of candida cells adhered were significantly higher in all the plasma treated surfaces than the unmodified control group (P < 0.001). It was concluded that improving the surface wettability of acrylic resins by glow-discharge plasma in O2 atmosphere increased the adherence of the C. albicans.

Topical nonsteroidal anti-inflammatory drugs versus oil of evening primrose in the treatment of mastalgia

OBJECTIVE

To compare oil of evening primrose (OEP) and topical nonsteroidal anti-inflammatory (NSAIDs) with respect to safety, effectiveness, rapidity of response, cost effectiveness and acceptability in the treatment of breast pain.

STUDY DESIGN

An open, non-randomised, comparative study of topical (NSAI) gel versus OEP was carried out, over a period of one year.

PATIENTS AND METHODS

Fifty female patients attending the outpatient department with moderate to severe breast pain were given one of the two agents alternatively, after selection.

RESULTS

Results showed that out of 25 patients treated with OEP, 64% had a clinically significant response after three months of treatment, compared with 92% with topical NSAIDs. Only one patient (4%) had side effects with OEP, while no patient had side effects with topical NSAIDs. Twenty per cent and seventy per cent showed acceptability as far as costs were concerned and mode of administration respectively, with OEP. The acceptability rate was 68% and 96% respectively, with topical NSAIDs.

CONCLUSION

This study has shown topical NSAIDs to be safe, effective, rapid and acceptable mode of treatment for cyclical and non-cyclical mastalgia.

The health assessment questionnaire (HAQ) is strongly predictive of good outcome in early diffuse scleroderma: results from an analysis of two randomized controlled trials in early diffuse scleroderma

OBJECTIVE

Scoring poorly on the health assessment questionnaire (HAQ) has recently been shown to be a strong predictor of morbidity and mortality in rheumatoid arthritis (RA), while a good HAQ score is predictive of a better outcome. In patients presenting with early diffuse scleroderma prognosis is variable. Our goal was to determine possible baseline predictors of future good outcomes.

METHODS

We used the raw data from two randomized controlled trials (RCTs) in early diffuse scleroderma: methotrexate (Pope et al.) and D-penicillamine (Clements et al.). Subjects in the methotrexate trial were divided into the following groups: (1) those with at least 20% improvement in the primary outcome measurements [patient global assessment, physician global assessment, UCLA skin tethering score, modified Rodnan skin score (MRSS), DLCO as % predicted and HAQ disability] at 1 yr vs (2) the others. Baseline factors (including age, gender, skin scores, physician and patient global assessments, HAQ disability and pain scores, DLCO and physical parameters) were analysed to find baseline variables strongly correlated with later improvement. These variables were explored in the D-penicillamine trial to determine if (in a separate trial) they were still predictive of improved outcome at 1 and 2 yr. Adjusted models were used to find baseline predictors of good outcome. The median HAQ-DI was 1.3 (methotrexate) and 1.0 (D-penicillamine).

RESULTS

A baseline HAQ disability score of less than the median was predictive of at least a 20% improvement at 1 and 2 yr with odds ratios of 1.77 to 5.05, in four of the five outcome measurements (in both groups); with strongly significant P values for 3 of 5 outcomes (UCLA skin score, MRSS, patient global skin score; P<0.02) from the methotrexate study group. These three outcomes were strongly correlated with improvement (r between 0.25 and 0.35). Although data from the D-penicillamine trial were less convincing, in both trials the less than median HAQ-DI and HAQ pain scores showed a stronger association with improved outcome, more so than age, gender, skin score and baseline global assessment.

CONCLUSION

A low baseline HAQ (defined as less than the median HAQ score) is predictive of improved outcome in diffuse scleroderma at 1 and 2 yr.

Sinuous pockmark belt as indicator of a shallow buried turbiditic channel on the lower slope of the Congo basin, West African margin

Pockmarks on the slope of the Lower Congo Basin are distributed along a meandering band on seafloor coincident with a shallow buried palaeochannel imaged from the 3D-seismic database. Each pockmark originates systematically at the channel-levee interface and the seafloor expression of the palaeochannel’s sinuosity is mimicked by the sinuous trend of pockmarks. 3D-seismic on the slope, calibrated by biostratigraphic data from cores of the Leg ODP 175, indicate a seaward decrease of the sedimentation rate. We suggest that this condition induces a differential loading of the hemipelagic cover over the palaeochannel and propose a model for episodic dewatering of fluids trapped in the buried turbiditic channel. The consequence is a fluid flow caused by a longitudinal pressure gradient along the buried channel. A hydromechanical model proposed for the formation of shallow pockmarks indicates that the sedimentation rate cannot generate the overpressure required for pockmark formation on the seafloor. Therefore, it is suggested that hydrocarbon migration from deeper overpressured reservoirs is added to the pore fluid pressure in the shallow subsurface sediments. Horizontal drainage by the turbiditic palaeochannel and vertical migration along many vertical conduits (seismic chimneys) probably initiated at shallow subbottom depth. It is concluded that these shallow processes have important implications for fluid migration from deeply buried hydrocarbon reservoirs.

Synergistic effect of cefepime on the phagocytic killing of Staphylococcus aureus by human polymorphonuclear leucocytes and the determination of this effect by means of nitrite production

In this study the effect of cefepime on the phagocytosis and intracellular killing of Staphylococcus aureus by human polymorphonuclear leucocytes (PMNL) was determined. The opsonophagocytic killing of S. aureus was synergistically enhanced by cefepime at concentrations below 0.5 times the minimal inhibitory concentration (MIC), and four times the MIC at higher concentrations. The effect of cefepime on phagocytosis and the bactericidal activity of PMNL was also investigated by the measurement of nitrite levels using a Sievers analyser. According to the nitrite levels, cefepime enhanced not only the phagocytosis by PMNL 2.1-fold in the 0.5 MIC and 2.8-fold in the four MIC values but also the bactericidal activity of neutrophils 2.5-fold in the 0.5 MIC and 2.8-fold in the four MIC values, respectively. The beneficial cefepime-leucocyte interaction may explain the efficacy of cefepime against intracellular pathogens.

Bacterial adhesion of Actinobacillus actinomycetemcomitans serotypes to titanium implants: SEM evaluation. A preliminary report

BACKGROUND

In this study, the adherence ability of Actinobacillus actinomycetemcomitans serotypes to titanium implant surfaces was evaluated to demonstrate if any selective adherence occurs according to the serotypes of the microorganism.

METHODS

The study material included 3 reference strains of A. actinomycetemcomitans serotypes a, b, and c (ATCC 29523, ATCC 43718, ATCC 33384) and 2 clinical isolates of A. actinomycetemcomitans serotypes d and e (IDH 781, IDH 1705), together with commercially available titanium blade implants. For each strain, bacterial suspensions with identical concentrations (5 x 10(7) cells/ml) were prepared and 0.5 ml of each was added on to the implant surfaces, which had been precoated with glycine-bovine serum albumin (BSA). After incubation at 37 degrees C for 60 minutes in 5% CO2 in air, the implants with attached bacteria were prepared for scanning electron microscopic (SEM) observations. Bacterial adhesion was quantified on the textured body surfaces of the implants, and results were statistically analyzed with analysis of variance followed by Duncan's test. The surface ultrastructure of the bacterial cells was also evaluated descriptively.

RESULTS

The tested strains adhered to implant surfaces in different quantities. Serotype a (ATCC 29523) showed the highest adherence affinity (statistically significant, P <0.01). When compared with each other, serotypes b, c, and d (ATCC 43718, ATCC 33384, and IDH 781) attached equally well, whereas serotype e (IDH 1705) had a statistically significant low adherence capability.

CONCLUSIONS

It is suggested that in vitro A. actinomycetemcomitans adhesion to implant surfaces is strain dependent.

Antimicrobial effects of various endodontic irrigants on selected microorganisms

AIM

This study was undertaken to determine the antimicrobial effect of various endodontic irrigants against six selected microorganisms.

METHODOLOGY

Staphylococcus aureus, Enterococcus faecalis, Streptococcus salivarius, Str. pyogenes, Escherichia coli and Candida albicans were included in the study. Pre-sterilized Whatman paper discs, 6 mm in diameter and soaked with the test solution, were prepared and placed onto the previously seeded agar Petri plates. Each plate was incubated aerobically. A zone of inhibition was recorded for each plate and the results were analysed statistically.

RESULTS

5.25% NaOCl was effective against all test microorganisms with a substantial zone of inhibition. Saline was always ineffective. Decreased concentration of NaOCl significantly reduced its antimicrobial effect. Cresophene showed a significantly larger (P < 0.05) average zone of inhibition compared to the other experimental irrigants. Alcohol had smaller but not significantly different zones of inhibition than chlorhexidine.

CONCLUSIONS

5.25% NaOCl was superior in its antimicrobial abilities compared with other irrigants used. A reduced concentration of NaOCl (0.5%) resulted in significantly decreased antimicrobial effects. When compared with 21% alcohol, 0.5% NaOCl and 2% chlorhexidine, paramonochlorophenol (cresophene) showed a greater antimicrobial effect.

Antimicrobial effects of various endodontic irrigants on selected microorganisms

AIM

This study was undertaken to determine the antimicrobial effect of various endodontic irrigants against six selected microorganisms.

METHODOLOGY

Staphylococcus aureus, Enterococcus faecalis, Streptococcus salivarius, Str. pyogenes, Escherichia coli and Candida albicans were included in the study. Pre-sterilized Whatman paper discs, 6 mm in diameter and soaked with the test solution, were prepared and placed onto the previously seeded agar Petri plates. Each plate was incubated aerobically. A zone of inhibition was recorded for each plate and the results were analysed statistically.

RESULTS

5.25% NaOCl was effective against all test microorganisms with a substantial zone of inhibition. Saline was always ineffective. Decreased concentration of NaOCl significantly reduced its antimicrobial effect. Cresophene showed a significantly larger (P < 0.05) average zone of inhibition compared to the other experimental irrigants. Alcohol had smaller but not significantly different zones of inhibition than chlorhexidine.

CONCLUSIONS

5.25% NaOCl was superior in its antimicrobial abilities compared with other irrigants used. A reduced concentration of NaOCl (0.5%) resulted in significantly decreased antimicrobial effects. When compared with 21% alcohol, 0.5% NaOCl and 2% chlorhexidine, paramonochlorophenol (cresophene) showed a greater antimicrobial effect.

Prevalence of high level aminoglycoside and vancomycin resistance among enterococci in Turkey

Enterococcus spp. have become the third most common cause of nosocomial infections. High-level aminoglycoside resistance (HLAR), an important clinical concern, has been associated with some species of enterococci. The synergistic effect obtained by the combination of aminoglycosides with penicillin or vancomycin disappears in strains that show high-level resistance (HLR) to the aminoglycosides. We evaluated the agar dilution and high content disk diffusion tests for the detection of HLAR for 60 isolated enterococci. In our study 4 strains of Enterococcus faecalis (6.6%) and 8 strains of Enterococcus faecium (13.3%), totally 20% were found to be highly resistant to gentamicin; 2 strains of E. faecalis (13.3%), 8 strains of E. faecium (3.3%), totally 16.6% showed HLR to streptomycin by agar dilution method and the same rates were found by high-content disk diffusion method. 2 strains of E. faecalis (3.3%), 4 strains of E. faecium (6.6%), totally 10% showed vancomycin resistance by agar dilution method. The ratio for beta lactamase activity was found to be 26.6% for E. faecalis and 3.3% for E. faecium. Our results demonstrate that high-content disk diffusion test should be performed by using both gentamicin and streptomycin in routine screening of HLAR among enterococci and the determination of beta lactamase activity at the same time is also useful for detecting resistance to a beta lactam agent.

Effect of a Staphylococcus epidermidis-extracted slime factor on human natural killer cell activity

A slime factor produced by Staphylococcus epidermidis was a complex glycoconjugate extracted by the phenol extraction method. The potential stimulatory or inhibitory capacity of the phenol-extracted slime (PES) was tested on human natural killer cell cytotoxic activity. Various concentrations of the PES preparation were incubated with the effector cells 30 min before and during the assay period. The PES factor inhibited natural killer cell cytotoxic activity at a concentration of 250 micrograms/ml and at higher concentrations (p < 0.05). The inhibition of natural killer cell cytotoxic activity may probably be related to the complex composition of the slime substance.

Brachial artery approach for transluminal angioplasty of the internal carotid artery

One possible problem in internal carotid angioplasty is inaccessibility of the lesion due to elongation of the aortic arch, the brachiocephalic trunk, or the carotid artery itself. A new approach to performing angioplasty of the right or left internal carotid artery utilizing the brachial artery was used after failure of the transfemoral approach in 5 lesions (4 patients). The common carotid artery was cannulated with performed 5F catheters. Angioplasty was performed with a conventional balloon dilatation catheter. If required, a Wall stent was implanted to optimize the angiographic result. After failure of the conventional transfemoral technique, the brachial technique permitted successful angioplasty of the ipsilateral internal carotid artery in 4 lesions and the contralateral internal carotid artery in 1 lesion. In 1 patient, a stent was implanted. No complications occurred. The mean stenosis diameter decreased from 77.8 +/- 6.3% to 17.8 +/- 9.1%. Doppler sonography performed 4-6 months later showed no restenosis. The brachial artery approach seems to be a suitable alternative to the femoral technique.

Circulating adhesion molecules ICAM-1, E-selectin, and von Willebrand factor in Henoch-Schönlein purpura

Adhesion molecules play an important part in leucocyte transendothelial migration and thus may provide a useful marker of surface expression at inflammatory sites. In 20 patients with Henoch-Schönlein purpura serum intercellular adhesion molecule 1 (ICAM-1), E-selectin, and plasma von Willebrand factor (vWF) were determined by ELISA during the active and inactive phase of the disease. Twelve healthy children were studied as a control group. Serum ICAM-1 concentrations increased during the active phase of the disease and differed significantly compared with the inactive phase (p < 0.05). However ICAM-1 in the active phase did not differ significantly compared with controls (p = 0.08). Serum E-selectin concentrations did not differ in the active and inactive phase of the disease. By contrast, vWF increased in the active phase of the disease and differed significantly compared with inactive disease and control groups (p < 0.01). Considering the adhesion molecules and vWF, only vWF correlated well with the C reactive protein measurement in the active phase, which is considered a good marker of disease activity. These data suggest that plasma vWF is a good marker of vascular inflammation and endothelial damage. Circulating ICAM-1 might be an additional parameter in some of the patients.

Intestinal endotoxins as co-factors of liver injury in obstructive jaundice

The concept of endotoxin-mediated rather than direct liver injury in biliary obstruction was investigated using the experimental rat model of bile duct ligation (BDL) and small bowel bacterial overgrowth (SBBO). Small identical doses of intravenous endotoxin (bacterial LPS) caused a significantly more severe liver injury in rats with BDL, compared with sham-operated rats, suggesting the possible contribution of LPS in this type of liver damage. BDL was then combined with surgically created jejunal self-filling blind loops, which resulted in SBBO. Plasma LPS level increased significantly, and once again a more severe liver injury, determined by liver histology and serum gamma-glutamyl transpeptidase levels, was observed compared with the control group of rats with BDL+self-emptying blind loops. The data presented suggest that small amounts of exogenous LPS and/or the ordinarily innocous amounts of LPS constantly absorbed from the intestinal tract may be critical in the hepatic damage caused by obstruction of the biliary tract.

Slime production by coagulase-negative staphylococci in the infected pulps

In this study; slime factor which is produced by coagulase negative Staphylococci was investigated in infected pulps of 145 primary and permanent teeth. Staphylococci were isolated in 27% of the cultures and all of the isolated Staphylococci were coagulase negative (CNS) in permanent teeth whereas 75% of isolated Staphylococci were coagulase negative in primary teeth. Slime production rate was the same for both groups and 22% of CNS were found slime positive. It is thought that slime production is important not only in endodontic microbiology, but also in other fields of dentistry for the explanation of the pathogenesis of infection.

[Retrograde catheter recanalization of long-range occlusion of the superficial femoral artery]

In a prospective study between March 1992 and October 1993, 50 consecutive patients (47 men, three women; mean age 59.7 [42-73] years) with a total of 52 occlusions of the superficial femoral artery underwent retrograde recanalization via the popliteal artery. The patients were in clinical stage IIa (n = 7), IIb (n = 38) or III (n = 5). The mean Doppler ratio (ankle/arm) was 0.51 +/- 0.14, mean length of occlusion 19 +/- 9 [4-40] cm. Popliteal puncture was successful in all patients but one. The occlusion was passed by guide-wire in 38, subsequently by balloon catheter in 37. Additional laser angioplasty had to be performed in five patients, while stent implantation was necessary in another five. 35 of 52 vessels (in 33 patients) remained open and free of significant stenosis after the procedure. The mean ankle/arm Doppler ratio was 0.5 +/- 0.13 immediately before the angioplasty, 0.72 +/- 0.17 (P < 0.05) immediately afterwards. There were no complications ascribable to the technique except in two cases in which an asymptomatic arteriovenous fistula developed. These results indicate that retrograde recanalization of the superficial femoral artery is a relatively reliable and successful catheter technique in patients who would otherwise have to be treated by surgery.

[Antibiotic sensitivity tests of methicillin-resistant staphylococci]

In this study, 231 Methicillin-Resistant Staphylococcus (MRS) and 76 Methicillin-Susceptible Staphylococcus (MSS) strains were investigated. 23 antibiotics were tested by using Modified Kirby-Bauer Technique. The highest resistance ration in MRS strains were found for lincomycin, clindamycin and ampicillin with the ratios of 61.0%, 59.3%, and 56.2% respectively. And the lowest resistance ratios were measured for vancomycin, ciprofloxacin and ofloxacin 0.5%, 8.2%, 10.8% respectively. It was found that, resistance of MRS strains to 17 antibiotics were significantly higher than resistance of MSS strains, but not for sulbactam-ampicillin, cefoperazone, ceftriaxone, vancomycin, ciprofloxacin, ofloxacin and netilmicin.

[Fungus-induced arthritis caused by Scedosporium apiospermum (Pseudallescheria Boydii)]

Scedosporium (monosporium) apiospermum is the most common causative agent of maduro mycosis. Recent research reports claim that this fungus can also induce arthritis. We report on the disease in a woman from a rural area who was admitted to our clinic because of arthritis symptoms. We were able to detect Scedosporium apiospermum, i.e., it was probably a fungus-induced arthritis which had developed after an intraarticular steroid injection.

[Staphylococcal protein A, bacteriocin, DNase and lactamases of methicillin-resistant Staphylococcus]

231 Methicillin-Resistant Staphylococcus (MRS) and 76 Methicillin-Susceptible Staphylococcus (MSS) strains were investigated for Staphylococcal Protein A, bacteriocin, DNase and beta lactamase production properties. It was found that 73.6% of the strains of MRS were positive for protein A, 3.8% for bacteriocin, 76.2% for DNase and 84.4% for beta lactamase production. And it was found that 61.8% of MSS strains were positive for protein A, 11.8% for bacteriocin, 55.2% for DNase and 57.9% for beta lactamase production. Staphylococcal protein A, DNase and lactamase production. Staphylococcal protein A, DNase and lactamase production were found to be significantly higher in MRS strains than MSS strains and bacteriocin production was found to be higher in MSS strains than MRS strains according to Chi Square Test.

Acute and chronic effects of a diuretic monotherapy with piretanide in congestive heart failure--a placebo-controlled trial

To evaluate the acute and chronic effects of diuretic monotherapy with 3 mg piretanide bid, 46 patients (pts) with congestive heart failure (NYHA II-III) secondary to coronary artery disease were studied. Within 3 weeks of therapy, the patients lost 1.6 kg body weight. Forty-four patients reported a subjective feeling of improvement. Echocardiographically, a highly significant (p less than 0.001) reduction of diastolic and systolic diameters was found, as well as an increase of fraction shortening. Chest x-ray indicated a reduction of heart volume from 1012 +/- 263 ml to 936 +/- 233 ml (p less than 0.001). The serum potassium level remained unchanged. A subgroup of 26 pts underwent invasive hemodynamic examinations. IV injection of 6 mg piretanide resulted in an acute reduction of pulmonary wedge pressure (pc) from 20.2 +/- 5.3 mmHg to 11.9 +/- 5.0 mmHg (p less than 0.001); simultaneously a slight decrease of cardiac index from 3.2 +/- 0.6 l/min/m2 to 3.0 +/- 0.4 l/min/m2 was observed. Invasive control after 3 weeks of oral therapy showed no decline of the piretanide effect. The exercise tolerance increased clearly from 135 +/- 161 Wmin to 249 +/- 268 Wmin (p less than 0.05). A control group of further 14 pts was treated with placebo only and did not show any significant changes of pc (20.0 +/- 6.4 mmHg vs. 22.8 +/- 19.2 mmHg), exercise tolerance, or other clinical parameters. Thus, the diuretic monotherapy of congestive heart failure with piretanide is highly effective and shows a significant improvement in all clinical and hemodynamic parameters in the absence of any remarkable side effects.

[A food-borne outbreak of group A streptococcal pharyngitis]

In August 1988, following a luncheon, an explosive epidemic of pharyngitis due to group A streptococci (M type 11, T type 3/13/B3264 and opacity factor positive) occurred among the staff of an institution in Ankara. Epidemiological investigation indicated that the outbreak was food-borne. A salad prepared by bean with boiled egg was incriminated as the vehicle of transmission. Group A streptococci were isolated from the throats of 37 (63.8 percent) of 58 persons with pharyngitis. High levels of antistreptolysin O titers were observed in serum samples from 39 (81.2 percent) of 48 persons with pharyngitis. Secondary transmission had accounted for only 3.8% of cases.

[Outbreak of food poisoning caused by Salmonella typhimurium]

In this paper, a food poisoning outbreak of 42 people who ate the sucuk (Turkish sausage flavored with garlic) which was made of the same meat has been described. Salmonella typhimurium was isolated from the stool of 20 patients and from the sucuk. Efficacy rate of Ofloxacin was 75 percent in these 20 patients treated Ofloxacin.